Diabetes Self-Management Education and Support Program is Almost as Effective as Metformin
By Steve Spencer
Unfortunately, the prevalence of diabetes in the United States is set to grow from 22 million people in 2014 to 39 million in 2030 with expectations of up to 61 million in 2060. At that point, it will affect nearly 20 percent of the population.
Diabetes has a huge impact on people’s lives. The demands are endless, as patients have to constantly manage food intake, monitoring sugar and carbohydrate consumption; check blood glucose levels; and administer insulin or medication.
Diabetes is an expensive disease, and the medical costs of healthcare alone for a diabetic are over two times more than for a person without diabetes. The condition can lead to life-altering and potentially fatal outcomes, including nerve damage, risk of stroke or heart attack, kidney damage, and vision problems.
With these complications, it’s important for diabetics to have a good understanding of the disease. This is where the Cullman Diabetes Center (CDC) enters the picture. The center incorporates the Diabetes Self-Management Education and Support (DSMES) program, which is accredited by the American Diabetes Association. The purpose is to help patients understand their diagnosis and build healthy habits. It has shown meaningful impacts nationwide. Studies have shown it can lower A1C by .055 percent to 1.3 percent. This is comparable to metformin, which typically reduces A1C by 1 to 1.5 percent.
“With the DSMES program, when a new patient comes in, we start with a one-on-one assessment,” said Morgan McHugh, CRNP. “We get their history. Then we help them set goals that are obtainable. For example, they might want to work on lowering their A1C level or maybe they want to exercise more. Then we focus on helping them stay motivated and giving them resources.
“In order to become re-accredited, we have to show that our patients met their goals. For example, if they had a goal of reducing the amount of carbs, we can set those standards to show that they met those goals. We’ve had a number of patients be very successful reaching their goals. I’ve had patients who wanted to avoid starting insulin, and they went through the program, and were able to keep their diabetes maintained.”
Alicia Lee, CRNP said “after the initial assessment, they can participate in additional classes that cover different aspects of diabetes management; things like nutrition, lifestyle, understanding the disease and managing it.”
CDC also trains patients to use insulin pumps. These pumps can replace the need for multiple daily injections, but it takes more than a quick tutorial to learn to use them effectively.
A number of patients want to use continuous glucose monitors to track their glucose levels, and the Cullman Diabetes Center provides training on the monitors, covering everything from sensor insertion to interpreting their glucose trends.
Nutrition is of upmost importance to diabetics so CDC has a Medical Nutrition Therapy (MNT) program. Here, the patient meets one-on-one with the program’s registered dietitian to review their current eating habits, discuss lab results and medications, and set customized goals that align with their health needs. Unlike general nutrition advice, this is a personalized approach to managing chronic conditions through food and lifestyle changes.
“This program benefits people in all stages of diabetes,” Alicia Lee said. “People who have just been diagnosed want to make sure they’re ready to handle it. It’s helpful with type 1 diabetes patients who need to understand insulin management and glucose monitoring.”
Morgan McHugh said, “and it’s good for type 2 patients who need to learn practical ways to manage blood sugar and improve their diet. This is also important when complicating factors arrived. We may have a patient who now has a new diagnosis of chronic kidney disease, in which case we may need to re-look at their plan.”
“Another critical time,” Lee said, “is when there is a transition of care. This could happen when a patient’s spouse has passed away. If that spouse took care of the medicines, we need to help the patient decide how to handle that. Another example is when we have an 18 or 19 year old also who’s transitioning out of pediatric care into the adult section now. This is a huge change for them. They’ll have much more responsibility.”
The CDC staff includes Medical Director Adam Harrison, DO, an LPN, a registered dietician, and the CRNPs Lee and McHugh.
With patients coming from Huntsville and Arab, and even some from Birmingham, it’s clear that there is a real need for the DSMES program that the Cullman Diabetes Center is providing.
